Slip and Fall

[OrlandoTommy]

Hello Everyone,

I had some quick questions in the midst of one of my normal panic attacks...

Last Saturday I was on a boat with some friends and someone hit the throttle which caused me to slip and fall about 5 feet down into the boat landing directly on my left knee.

Immediatly it swelled up like a softball and the pain was intense. The next day i hobbled around hoping the swelling would go down and it did.

I was going to not even go to a doctor but the next day (day 3) i couldnt even bend my knee it hurt so bad so i went to the ER at Tampa General. They did some Xrays and said it wasnt broke but didnt do a MRI because of my mechanical heart valve.

Either way 2 docs saw it and said just stay off it it and take some anti inflammatory meds and it should get better. The anti inflam drugs just made things hurt worse so i stopped taking them that night.

The next day i went to my local docs here in Orlando and he basically said the same thing, just stay off of it etc.. etc.. He gave me some Lortabs which also DONT work..

The pain has went away on its own but my leg directly under my knee started to swell a little bit, then after work yesterday i got home and my left foot was swollen. I took my sock off and it seemed to be black and blue swollen. I have a big black and blue on my leg. It seems to go down to normal in the AM but if i walk around on it it puffs back up.

In the midst of all of this my doc here in Orlando told me to skip my coumadin for 1 night so i did. Well i checked my levels yesterday and they were 1.7, today they were 1.8! Usually they are 3.5 all the time, im on 7mg of coumadin a day.

I forgot to mention i have been walking around, up and down steps on my foot ever since the injury happened ALOT, i know i shouldnt have but i have. My car is also a stick shift and pushing the clutch in is sheer agony.

I think anyone falling down like i did then walking on a injured knee would have the same result but the black and blue scares me. I know you can bleed to death on coumadin. Its not getting worse now but it just doesnt seem to be getting a whole lot better.

Is this normal for it to take a week or so for the black and blue to go away and swelling to go away, has anyone else had a nasty bump/fall and had black and blue, im really freaking out and im sick of ER's that keep me there for 2 days just to send me home and tell me everything will be fine.

Im sure everyone knows what im talking about.

Uhg, life sucks.


Tommy

 

[Bina]

Tommy....why were you doing gymnastics on a power boat???

I don't know why your doc told you to skip a dose of Coumadin, that just does not make sense, especially when you can test at home.
If he wanted the INR lower, a half dose would have worked out.

REST that leg!!
Walking is good for the circulation, but no stairs and no clutch pedals.
(I'm feeling bossy today)

 

[Nancy]

Several years ago Joe had a terrible slip and fall accident on some ice. Nothing was broken, but he was actually black, not blue from his kidney area to his foot. I've never seen anything like it. He continued to bleed and eventually had to go off Coumadin for a couple of weeks because his blood count was very low. He needed physical therapy to help him regain his walking abilities. He was also hospitalized for a week, and then two weeks in a rehab facility.

So, yes, even though your accident probably wasn't as severe, you should be keeping close contact with your doctor. I think Marty (a member here) had a bad fall, and eded up wth compartment syndrome (you could search for that phrase). So things can happen. Keep a good eye on it, and don't fool around with it.

 

[Philip B]

Bruises

Bruises

Hi Tommy,

I took a nasty fall while riding my mountain bike a couple of weeks ago and still have bruises from the bike landing on top of me. I also dislocated several fingers on my left hand. Your crash sounds worse than mine.

My fingers still swell with lots of use and the joint pain is still bothersome. It's pretty normal for these kinds of injuries to swell and hurt with use.

My bruises are finally beginning to fade. I'm accustomed to these kinds of injuries (I broke both of my knees in a mountain climbing accident in the early 80's) and the healing process takes time whether the individual is on coumadin or not. It takes longer when one's lifestyle is active.

The recommendations the doctors have given you about staying off the leg are pretty standard for this kind of injury. Propping your leg up when you are sitting and using ice or cold packs to reduce swelling are also pretty standard.

The coumadin thing is worrysome. In my first few weeks post-op, I had several nose bleeds that lasted for hours.

Hang in there, take it easy, and monitor the injury.

-Philip

 

[Elcarim]

Knees are cranky things anyway. Before I was on warfarin I was thrown from a horse (imagine a clown being shot out of a cannon, that was my trajectory) and landed on my face and knee. My helmet protected my face, but my knee was pretty banged up. I drove home, but it swelled up over a couple of days and was weeks before it was right again.

Not wanting to sound like a nag, but you went to the bother of seeing doctors and then ignored their advice... kept walking on the leg and didn't take the anti-inflams.

In the scheme of things I think what you are experiencing is normal. My bruises take weeks to go away, and you had a pretty bad fall then kept walking on the leg... did you ice your knee when you first injured it? That is the first thing I do when I have a big bump.

Actually, I had a horse stomp on my foot a few months ago. I iced it and rested it, but it still swelled up and hurt for days and the bruise took about three weeks to go away.

In my unqualified opinion, I think you will be fine

 

[OrlandoTommy]

Update

Update

Just a little update, thanks for your info everyone by the way...

My knee is still swollen, but its getting easier to bend. Im mad at the doc who told me to stop my coumadin for a night, my levels for the past 4 days have been 1.8, for the last 4 months they have been 3.3, i stopped one night of coumadin and that happened!!
Now being at 1.8 i know that isnt good, so i have some 1mg tablets i have been taking in the AM and at nights i take the full 6mg.
I was also drinking the past couple months often, not sure if that can raise it up higher but i stopped the drinking...im really frustrated with this coumadin crap, my levels had been so perfect now im back to biting my nails every second waiting to be hit with double vision again
Tommy

 

[Karlynn]

Tommy,
Now you've experienced 1st hand one of the big mantras of a Coumadin user "It's much easier to lower a high INR than it is to raise a low INR." This is one of the reasons we tell people to not let their managers try and keep them at the low end of their range.

Rather than taking a little in the morning and your regular dose at night you should just increase your daily dose 10% and test in 3 days to see if you're back in range. When you get back in range - go back to the dose that kept you in range.

 

[OrlandoTommy]

Hi there, if my daily dose is 7MG (1 mg tablet and one 6mg tablet) how would i increase that by 10%?

Have your levels ever dropped low before?

Thanks,
Tommy

 

[Cooker]

you are on 49mg a week. 10% 4.9mg Break a 7 in half. take that and one or two 1mg with it.

 

[Bina]

Well Tommy, maybe you've done a bit of partying too soon after OHS.

Don't freak out about your INR, the doc made a bad call having you skip that dose, but everything is fixable.
Keep track of all your doses on a calendar, agenda, whatever, and you will soon know what are good dose decisions for you.

 

[Lynlw]

Tommy, I'm curious why they said you couldn't have n MRI because of a mechvalve. Do you have a walet card? I THOUGHT most mech valves were ok for MRIs, it should say on your card if your valve is MRI compatable.
I hope you are feeling better soon and have the unnecessary frustration. Lyn

 

[OrlandoTommy]

Hi there, just a quick update...

Its been over a week since my fall, my swelling has went down alot but my foot is still black and blue.

My coumdain levels are really making me furious though, i have been taking 9-10mg a day instead of my usual 7, a asprin too and on sunday my levels were 2.0, then yesterday they were 1.8 again!

I dont know but im getting tired of this, they were PERFECT for months, i miss one dose and now they are 1.8 everyday!

Has anyone else had this kind of issue with missing a dose and there levels dropping, how long does it take to get back to normal?

PS: About my mech valve, i do have a wallet card and it has MRI settings on it, but usually they dont even watn to mess with a MRI since i have a valve..

Thanks everyone,
Tommy

 

[Bina]

Hi Tommy,
At 3 weeks post op my INR was 1.8 and I went to the ER for heparin.
Hang in there!

 

[Karlynn]

Sounds like you need to give yourself a bit of a bump again and keep it at that for a few days. I would recommend not testing any more than every 3 days. Anything from 2-5 INR is not going to put you in danger. raising your dose by 10% and testing in 3 days shouldn't set you over the top. It will take 3 days for the dose you take today to reflect in your INR.

Now you know why we do a little freaking out over doctors telling people to hold doses. I've only (intentionally) held a dose 1 time in almost 16 years. I've taken half-doses for high INR's.

I can kind of understand why the doctor told you to do this. He was afraid of you bleeding in the knee area. But he probably should have had you decrease your dose a bit to bring your INR down a little to be cautious and then monitor you for signs that you were continuing to bleed into the knee. The knee should show bleeding fairly easily. It's the deep tissue bleeds that can be stealthy.

 

[OrlandoTommy]

so you think i should continue with my 9mg a day and asprin and just test every 3 days? thanks for your advice on this too everyone.

 

[ALCapshaw2]

Coumadin Rule #? - NEVER Skip a Dose because some Doc (who doesn't manage Coumadin patients) tells you to do so.

Coumadin Rule # x+1 - You Black and Blue 'coloration' will last 6 WEEKS.
(Been there, Done That, Dog>Shin>Tree,
BP Cuff Maxed Out>Arm Black and Blue from Biceps to Wrist).

'AL Capshaw'

 

[Karlynn]

Tommy, you said you were taking 9-10. So what is it. Give us a weekly total. (Which is how you should be adjusting your dosage - a % of the weekly total). You need to be concrete in your dosage changes so you know what steps to take next based on your results.

If you were taking 7/day and it kept you at 3.5, I'd be inclined to tell you to stay at your increase for a few more days. Are you taking any other medications for your knee incident? This may also affect your INR. So let us know.

Remember that aspirin does not affect your INR#.

Also remember that I'm not a medical professional. Just basing my suggestions on what I would do from my experience. Everyone reacts differently.

 

[OrlandoTommy]

for the last 3+ months i have been taking 7mg a day (1 1mg pill and 1 6mg pill). My INR has been steady, almost perfect at 3.3-3.6.

I hurt my knee a week or so ago and i missed one day of coumadin per my docs request and the next day my levels were at 1.8, they have been at 1.8 for the last week and a half.

for the last 4 days i have been taking a 6mg pill and a half of a 6mg pill, total of 9mg per day, still at 1.8.. i dont eat greens and stayed away from vitamin k.

the last 3 months i was drinking alcohol almost every night and the past couple weeks i havent had any since my injury, not sure if that makes a difference.

uhg im frustrated!

 

[Karlynn]

the last 3 months i was drinking alcohol almost every night and the past couple weeks i havent had any since my injury, not sure if that makes a difference.

uhg im frustrated!

We may be getting somewhere now. This could be the reason your new dose isn't raising your INR. For some, alcohol will raise the INR. If nightly alcohol was constant prior to the knee injury and notw you've gone to nothing, this could be the reason. I was taking less coumadin when I was having a nightly glass of red wine. The sulfides have wrecked havoc on me so wine is no longer in my nightly ritual. My Coumadin dose needed to be increased.

Even if you didn't skip a dose, or have a knee injury, but just stopped with the nightly alcohol, you probably would have seen a drop in your INR. With the knee injury and the direction to skip a dose, your INR dropped due to the skipped dose, but continued to drop with the stopping of the nightly alcohol - or thus is my educated guess.

A 10% increase of 9/day (63/week) is approximately 10/day (70/week).

If you're feel very unprotected you could increase to 10/day. I hesitate to keep talking about what you should do with doses. I think you should speak to your Coumadin manager (if you have one that is half-way reliable) and run your ideas past them.

But I'm willing to bet that the alcohol and the stopping of it, is the reason you're having a hard time getting in range now with a higher dose.

Also - don't test every day - you'll just frustrate yourself daily (who wants that! ) and you'll be messing with your dose daily and then you'll never get in range and start bouncing around between highs and lows.